2022 Nebraska Youth Range Camp Application
Please use this for to apply for the Nebraska Youth Range Camp which will be held June 6 - 9, 2022 in Curtis, Nebraska.  Students between the ages of 14 and 18 are eligible to apply.  This application must be fully completed, or it will not be considered.  Please take time to avoid typos.  If you would like to print a copy, please contact Blair Hartman at blairhartman.ne@gmail.com or 308.883.0446.  A health and parental consent form will be mailed after your online application is received.  Applications will be accepted until May 20, 2022.
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First name *
Last name *
Gender *
T-shirt size (adult uni-sex size) *
Date of birth *
Address *
City *
State *
Zip code *
County of residence *
What Natural Resource District do you reside in? *
Please visit https://www.nrdnet.org/nrds/find-your-nrd if you need help.
Applicant phone number *
Parent/Guardian Name(s) *
Parent/Guardian cell phone number(s) *
Parent/Guardian home phone number(s) *
Student e-mail address *
Most information will be sent via email and your address will not be shared.
Parent/Guardian e-mail address *
Most information will be sent via email and your address will not be shared.
Name of school currently attending *
Planned year of high school graduation *
Name of sponsoring group or agency
Have you previously attended the Nebraska Youth Range Camp? *
If so, which years did you attend?
List school and community activities *
List past range activities (include school, ranch, or farm work) *
How many range contests have you participated in? *
List awards and honors from the last two years *
What do you expect to gain from the Nebraska Youth Range Camp? *
Where did you hear about the Nebraska Youth Range Camp? *
I understand that I am required to have my parents/guardian complete the Health and Insurance Waiver (one will be emailed to the addresses provided on this application and the form can be found on our website at http://www.nesrm.org/YouthRangeCamp.html). *
I understand that full payment of $75 must be submitted to the Nebraska Youth Range Camp prior to May 27, 2022.  Payment can be made by mailing a check to Nebraska Youth Range Camp, 909 Fairfield Street, Ansley, NE 68814 or email Blair at blairhartman.ne@gmail.com and she will send you an invoice that can be paid with a credit or debit card.  Please contact your local NRD, 4-H Advisor, and/or FFA Advisor to find sponsorships to offset the cost. *
I understand that my application must be complete for it to be considered.  You will be contacted if you are selected to attend Range Camp. *
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